Nutrition & Diabetes Info

Hope applies her training and expertise as a dietitian, certified diabetes educator and weight management counselor to help clients manage the many aspects and challenges of these health conditionns. Below are answers to commonly asked quesetions that Hope share with clients about prediabetes, diabetes, diabetes diets, diabetes meal planning and healthy restaurant eating. You'll also find some reliable resources on these topics.

Prediabetes

Today prediabetes is considered a diagnosis and a medical condition. It's when blood glucose (also called blood sugar) is higher than normal, but not high enough to be diagnosed as diabetes (see the numbers to diagnose diabetes below). Other names you may hear of for this condition are "impaired glucose tolerance" or "impaired fasting glucose".

Two things are happening in the body when people develop prediabetes.

First, people slowly lose their insulin - making cells - beta cells. By the time type 2 diabetes is diagnosed people have often lost more than half of their beta cells. The body is working overtime to produce more and more insulin. When it can no longer produce enough insulin, blood glucose it rises into prediabetes ranges.

Second, people develop a relative insulin deficiency - a lot of insulin is produced but there's not enough insulin being made to cover the needs. Also, people typically develop insulin resistance—when the body's cells aren't able to use the insulin it makes. The body is essentially insensitive, or resistant, to the insulin the body does make. Learn more in Insulin Resistance, Weight Gain and Type 2 Diabetes: Connect the Dots.

Notes: These numbers do not apply to pregnant women and for the diagnosis of gestational diabetes. If the results from one test are not convincingly indicative of the diagnosis, then a repeat test should be done on a different day.

*Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of blood glucose during that time. Since 2010 the American Diabetes Association and other diabetes organizations around the globe consider the A1C test the preferred measure to diagnose diabetes because it provides a better picture of glucose ups and downs over time. A1C is also used to monitor how diabetes is being managed.

According to the Centers for Disease Control and Prevention (CDC) there are now 86 million Americans estimated to have prediabetes. Breaking this whooping number, down that’s 35 percent of adults over 20 years old and a mind-boggling 51 percent of adults over 65!

Yet, according to the latest CDC estimate from 2013, only 11 percent of people with prediabetes know they have it. That’s unfortunate because you can’t do anything about something you don’t know you have. Get these and more diabetes facts from CDC here.

Good news! The number of people who are aware that they have prediabetes is ticking up. Hopefully as awareness efforts climb the number of diabetes prevention programs will continue to expand. Learn more about the National Diabetes Prevention Programs.

There are a number of risk factors for prediabetes and type 2 diabetes. Prediabetes will often progress to type 2 diabetes especially if a person with prediabetes doesn’t take early action. Read: Can prediabetes be reversed or slowed?

Risk Factors for Prediabetes and Type 2 Diabetes:

Above 45 years old

Family history of type 2 diabetes (parent, brother or sister)

Member of an ethnic group with increased risk: African American, Hispanic/Latino, Asian American or Pacific Islanders, American Indian or Alaska Native

Diagnosed with gestational diabetes or given birth to a baby weighing more than 9 pounds

The diagnosis of prediabetes can be done with a blood glucose test (blood from a vein, not a finger stick) or by getting an A1C blood test (read below to learn more about the A1C test). If you suspect you may have prediabetes because you have one or more of the risk factors, a good first step is to take the American Diabetes Association risk test. Access this test and learn more about diabetes by reading this blog: Diabetes Alert Day 2015: At Risk? Take Action Now!

Notes: These numbers do not apply to pregnant women and for the diagnosis of gestational diabetes. If the results from one test are not convincingly indicative of the diagnosis, then a repeat test should be done on a different day.

*Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of blood glucose during that time. Since 2010 the American Diabetes Association and other diabetes organizations around the globe consider the A1C test the preferred measure to diagnose diabetes because it provides a better picture of glucose ups and downs over time. A1C is also used to monitor how diabetes is being managed.

Research from around the globe over the last twenty years shows that a 7 percent weight loss, healthier calorie-conscious eating and regular physical activity can reverse, halt, or slow the progression of type 2 diabetes. Of course, to continue to halt or slow the progression of prediabetes or progression to type 2 diabetes people need to keep as many of those pounds off as possible, eat healthfully and continue regular physical activity.

The large study on prediabetes done in the US is called the Diabetes Prevention Program (DPP). The initial 3 years of the study (the treatment phase), showed that losing about 5 to 7 percent of body weight (from the person's starting body weight) and getting 150 minutes of physical activity (usually walking) a week (30 minutes 5 times a week), helped people slow the progression from prediabetes to type 2 diabetes quite successfully. Yes, research has time and again shown that taking actions to eat less fat, count calories and be more physically active can reverse or slow the progression from prediabetes to type 2 diabetes. Research also has shown that many people can be even more successful adding regular counseling and support to help them make and practice healthier habits. You may want to consider working with a registered dietitian or other trained health professional to increase your likelihood for long term success with weight control and preventing type 2 diabetes.

Participants in the lifestyle change group did better than people who didn’t get this counseling but did take the glucose lowering medication metformin. (Learn more about whether people with prediabetes should take metformin. People in this group reduced progression to type 2 diabetes by about 30 percent versus those who received no treatment (control group).

After following most of the participants in the DPP in the continuing study, the DPP Outcomes Study(DPPOS), at 10 years, those in the original lifestyle change group continued to reduce their progression to type 2 diabetes the most—about 35 percent—and those in the initial metformin group about 20 percent versus standard care. Recently, 15 year data from DPPOS showed continued reduction in the incidence of type 2 diabetes. The original lifestyle group had a 27 percent greater reduction and the metformin group a 17 percent reduced incidence versus standard care.

Take a blood glucose lowering and other medications, such as lipid lowering and blood pressure medications, if they’re recommended to control and keep your glucose, lipids and blood pressure under control. Learn more about these targets here.

My book Diabetes Meal Planning Made Easy can help you make the type of step by step changes people did in the diabetes prevention studies around the goal to eat healthier and trim off a few pounds.

What the research shows is that once most people are diagnosed with prediabetes they’ve already lost somewhere in the range of 50 to 80 percent of their insulin-making capabilities. While some people who are diagnosed with prediabetes catch it very early and can lose and keep off a significant amount of weight can reverse prediabetes, most people aren’t able to to do. It’s hard work! The Diabetes Prevention Program (DPP) study (which became the Diabetes Prevention Program Outcomes Study (DPPOS)) showed that as the years progressed, fewer people where able to reverse their prediabetes. Read more about the DPP and DPPOS.

Research shows that people who have both elevated fasting glucose and A1c levels when they’re diagnosed with prediabetes are more likely to develop type 2 than people who have just one of these risk factors.

Research from the DPP study (after the intensive first three years) found 4 independent predictors of reversing prediabetes and returning blood glucose levels to normal.

They were:

glucose levels closer to normal when they entered the study (which means their higher than normal glucose levels were caught early)

younger age at diagnosis

greater ability to continue to make the insulin needed by the body

lost more weight

The American Diabetes Association (ADA) currently prefers the term remission, rather than the word cure. This is defined by ADA as achieving glucose levels below the diabetes range without taking any glucose lowering medications. Remission implies the strong possibility of a relapse if a person regains the lost weight and/or as aging ensues. So, even if prediabetes goes into remission, it can’t be erased from a person’s checklist of health concerns. Most experts agree if a person has had prediabetes or type 2 diabetes in their medical history that they get an A1c test once a year to keep abreast of their glucose status.

Today 7 percent of pregnant women develop gestational diabetes. According to CDC, this number is escalating. That’s in part because more women are overweight and/or older when they get pregnant. Research also shows that over half of women diagnosed with diabetes during pregnancy will develop type 2 diabetes within the next decade. Staggering stats!

Women who’ve had gestational diabetes are encouraged to take the following actions to prevent prediabetes and type 2 diabetes.

About 6 to 12 weeks after pregnancy, at an after pregnancy visit with a healthcare provider, American Diabetes Association and other organizations concur that women who’ve had gestational diabetes should have an oral glucose tolerance test (OGTT). An Oral Glucose Tolerance Test (OGTT) is when after an overnight (10 hour) fast the women has a sample of blood drawn for an initial blood glucose check. The woman then drinks 75 grams of glucose solution. Then they have blood drawn at 30 minutes, 1 hour and 2 hours after drinking the glucose solution (see results of the OGTT below).

Annually or at least every 3 years women should get a glucose or A1c test and be screened for diabetes. Learn more about how diabetes is diagnosed.

In addition, women who’ve had gestational diabetes and have been diagnosed with prediabetes or have strong risk factors for developing type 2 diabetes should talk to their healthcare provider about adding the blood glucose lowering medication metformin to decrease insulin resistance. Some research shows metformin was even more effective at reducing the incidence of type 2 diabetes in women at risk than in women who didn’t have gestational diabetes. Learn more about the use of metformin in prediabetes.

The US Food and Drug Administration (FDA) has not yet approved any blood glucose lowering medication for prediabetes. Several of the blood glucose lowering medications that are approved for use in people with type 2 diabetes have been used in diabetes prevention studies, including metformin in the Diabetes Prevention Program study.

Healthcare providers can prescribe these medications, so-called “off label.” Due to the incidence of prediabetes and growing evidence for the effectiveness of metformin in concert with weight loss, healthy eating and physical activity to slow the progression of type 2, metformin is being prescribed more often for this purpose. Metformin is generic, has been around a long time and has been well-studied. In addition to having a beneficial effect on insulin resistance some research points to the beneficial effects of metformin on lowering heart disease and some cancers.

If you have prediabetes pose the question of whether you should take metformin to your healthcare provider.

If you’ve been recently diagnosed with prediabetes or type 2 diabetes or know people with diabetes symptoms, you aren't alone. There are now more than 29 million people (about one in 9) in the U.S. with diabetes and over 300 million people with diabetes worldwide. Unfortunately, the numbers keep going up!

As rates of overweight and obesity rises, so goes prediabetes and type 2 diabetes. Yes, we have an epidemic of both on our hands. The rise of prediabetes and diabetes in the U.S. and worldwide are due in part to:

large increase in numbers of adults and children who are overweight

people are sedentary - not active

the population is aging and people who are older are more glucose intolerant

the number of people from ethnic groups with a high incidence of diabetes symptoms is growing in the US (African American, Hispanic American, Native American/American Indian, Asian Americans and Pacific Islanders)

You may wonder why doesn’t everyone who is overweight get prediabetes or type 2 diabetes? The answer: While being overweight or obese causes the body’s cells to be resistant to the effects of insulin, but insulin resistance alone isn’t enough to cause glucose levels to rise. What the research shows us is that developing prediabetes takes a combination of insulin resistance and a relative deficiency of insulin being made by the body. The amount of insulin a person’s pancreas can make is very much influenced by their genes.

Yes, there’s definitely a genetic factor here. People who inherit genes linked to type 2 diabetes and are also carry around extra pounds may eventually not be able to keep making the larger amounts of insulin they need to overcome their insulin resistance. People who are overweight but don’t have these genes seem to be able to keep their insulin production up at least for the time being.

Diabetes: 101

Diabetes, whether type 1, type 2 is actually quite easy to diagnose. A diagnosis can generally be made based on one or more blood tests for glucose (blood from a vein, not a finger) and/or an A1C test (see definition below).

If you have risk factors for diabetes (type 2) (see below) or think you have diabetes get your numbers checked by a healthcare provider. According to the American Diabetes Association, if you’re over 45, regardless of any risk factors, you should get your A1c or glucose level tested annually. If you’re younger than 45, overweight and have other risk factors (see below), get your A1c or glucose tested annually. If you’re at high risk (see risk factors below), follow up with your healthcare provider. Get tested and know for sure.

Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of your blood glucose during that time. Since 2010 the American Diabetes Association and other diabetes organizations around the globe consider the A1C test the preferred measure to diagnose diabetes because it provides a better picture of glucose ups and downs over time. A1C is also used to monitor how diabetes is being managed.

Type 2 Diabetes and Prediabetes Risk Factors:

Above 45 years old

Family history of type 2 diabetes (parent, brother or sister)

Member of an ethnic group with increased risk: African American, Hispanic/Latino, Asian American or Pacific Islanders, American Indian or Alaska Native

Diagnosed with gestational diabetes or given birth to a baby weighing more than 9 pounds

Notes: These numbers do not apply to pregnant women and for the diagnosis of gestational diabetes. If the results from one test are not convincingly indicative of the diagnosis, then a repeat test should be done on a different day.

*Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of blood glucose during that time. Since 2010 the American Diabetes Association and other diabetes organizations around the globe consider the A1C test the preferred measure to diagnose diabetes because it provides a better picture of glucose ups and downs over time. A1C is also used to monitor how diabetes is being managed.

Keep in mind there is no such thing as "borderline diabetes" or a "touch of sugar"- either you have diabetes or you don't. Get tested, know for sure. You may have prediabetes. Learn more about prediabetes.

People diagnosed with type 1 diabetes most often develop symptoms of diabetes prior being diagnosed and their blood glucose levels can get quite high prior to being diagnosed. The common diabetes symptoms are: thirst, frequent urinating, hunger, weight loss and tiredness.

For people diagnosed with type 2 diabetes it is quite common to not have any symptoms of diabetes at diagnosis. It’s important to note that a person diagnosed with type 2 diabetes has likely had progressively elevated blood glucose levels (in the range for prediabetes – see chart above) for many years prior to being diagnosed. Learn more in Insulin Resistance, Weight Gain and Type 2 Diabetes: Connect the Dots . If you need assistance with weight loss and knowing what and what not to eat with diabetes check out my book Diabetes Meal Planning Made Easy.

If you think you’re at risk for or have diabetes get tested as soon as possible.

If you have diabetes, take it seriously! Take action now!

If you are diagnosed with diabetes, get serious NOW! Don’t delay and don’t deny! Too many people don't realize that it is so important to take care of diabetes from day one to prevent and/or delay the complications of diabetes.

Today we know from studies that taking early action and being aggressive with your care to keep your glucose, blood lipids (fats) and blood pressure in target ranges over time is what’s critically important to get and keep you healthy. Learn more about the large National Institutes of Health study in type 2 diabetes, called the Look AHEAD study that showed some benefits of early action and weight control over time.

Target Ranges for Glucose, Lipids and Blood Pressure*

Glucose Targets

Lipid Targets

Blood Pressure Targets

A1C: <7%

LDL: <100 mg/dl

<140/90 mmHg

Glucose fasting and before meals: 80–130 mg/dl

HDL: >50 mg/dl

Glucose after meals: <180 mg/dl

Triglycerides: <150 mg/dl

*The American Diabetes Association recommends these targets for most people with diabetes, however, there are exceptions. You and your health care providers should decide on which goals are right for you based on your individual situation, age and health.

Most people with diabetes have type 2 diabetes (about 90%). Many people with type 2 diabetes are overweight (at least 80%). Therefore early on the most important thing to do is loose a few pounds and keep as many of those lost pounds off as you can. Learn more about what it takes: The Truths about Keeping Pounds at Bay.

Today there is no such thing as a diabetic diet. Eating to control diabetes is simply healthy eating. What’s not so simple is doing it!

Current guidelines recommend that most people with type 2 diabetes need to take at least one glucose lowering medication. Most recommendations suggest starting with the medication metformin which helps decrease insulin resistance. Remember, what's most important is that you keep your blood glucose, lipids and blood pressure in control over the years (see these goals in the table above).

If you have type 1 diabetes, you need to become knowledgeable about how food affects your blood glucose levels. Most people with type 1 and those with type 2 diabetes who take insulin use a method of meal planning called carbohydrate counting. To learn more about carbohydrate counting check out my book Complete Guide to Carb Counting.

Whether you have type 1 or type 2 diabetes consider partnering up with a diabetes educator to learn how to balance food, insulin and physical activity. Learn how to find a diabetes educator or diabetes education program. Contact me if you'd like to schedule a consultation.

To stay healthy and complications-free with diabetes for years to come you need to control your blood glucose levels day to day and over the years. Yes, easier said than done. To accomplish this requires careful attention to eating, physical activity and management of your glucose lowering medication. That means if your blood glucose levels aren't under control, work with your health care provider and diabetes educator to get and keep them under control.

Yes, over the years people with type 2 diabetes must progress their diabetes medications to match the progression of diabetes (translated that’s their dwindling supply of insulin). Learn more about this progression and what to do about it in my book Diabetes Meal Planning Made Easy.

Today we know that it takes more than managing glucose levels to stay healthy and complications-free over the years. Studies show that taking early action and being aggressive with your care to keep not just your glucose levels but also your blood lipids (fats) and blood pressure in target ranges over time is what’s critically important. Check out the glucose, lipid and blood pressure goals below.

Target Ranges for Glucose, Lipids and Blood Pressure*

Glucose Targets

Lipid Targets

Blood Pressure Targets

A1C**: <7%

LDL: <100 mg/dl

<140/90 mmHg

Glucose fasting and before meals: 80–130 mg/dl

HDL: >50 mg/dl

Glucose after meals: <180 mg/dl

Triglycerides: <150 mg/dl

*The American Diabetes Association recommends these targets for most people with diabetes, however, there are exceptions. You and your health care providers should decide on which goals are right for you based on your individual situation, age and health.

** Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of your blood glucose during that time.

As the saying goes, knowledge is power! The best way for you to learn about diabetes and take care of yourself now and for the long run is to get to know a diabetes educator or a group of educators at a diabetes education program. You'll find diabetes education programs at many large and small hospitals. Today there are also more and more independent diabetes educators in private practice and education programs are showing up in supermarkets, pharmacies and even online. This will become more common as technology provides us with virtual solutions to deliver diabetes education and support.

Ask your healthcare provider for a referral to a diabetes educator or diabetes education program (Alert: yes, you may need to ask.)

There are two excellent routes to finding a diabetes education program that is either recognized through the American Diabetes Association or accredited through the American Association of Diabetes Educators (AADE). This service is referred to by Medicare and some healthcare plans as Diabetes Self-Management Education and Support (DSMES) or Diabetes Self- Management Training (DSMT). The DSMES services you are eligible to receive will depend on what your health plan covers. Medicare covers DSMES as a Medicare benefit under Part B.

Here’s how to find a diabetes educator or diabetes education program in your area:

The American Diabetes Association (ADA) approves diabetes education programs around the US through an application and recognition process. Going to an ADA “Recognized Program” ensures that you receive quality diabetes education. You can find ADA Recognized Education Programs in your area online or by calling ADA at 1-800-DIABETES (1-800-342-2383).

The American Association of Diabetes Educators (AADE): Many diabetes educators belong to this professional organization. Diabetes educators may be nurses, nurse practitioners, dietitians, exercise physiologists, pharmacists, social workers, behavioral counselors, or psychologists. You’ll find diabetes educators working at the ADA Recognized Education Programs (mentioned above). AADE also has a process for accrediting diabetes education programs. Going to an AADE accredited program ensures that you receive quality diabetes education. To find an AADE accredited program go to AADE's website and then search for diabetes educators by your city and zip code.

If you can’t find a program through one of the routes above, contact your local hospital, ask your healthcare provider or ask other people with diabetes you know to recommend a nearby diabetes education program.

Don't think about diabetes education as a one-time visit. Read what this says again, Diabetes Self-Management Education and Support. Yes, getting ongoing support is a very important aspect of taking care of your diabetes and yourself.

You'll need both education and support as you strive to manage your diabetes.

More and more health plans realize that covering the cost of diabetes education and/or nutrition counseling (known as medical nutrition therapy) is beneficial. Medicare does cover both under Part B (outpatient services) and many other health plans do as well. The best advice is to contact your health plan to determine what Diabetes Self-Management Education and Support (DSMES) services they pay for. Put up a fuss if they say they don't!!

Here’s how to find a diabetes educator or diabetes education program in your area:

The American Diabetes Association (ADA) approves diabetes education programs around the US through an application and recognition process. Going to an ADA “Recognized Program” ensures that you receive quality diabetes education. You can find ADA Recognized Education Programs in your area online or by calling ADA at 1-800-DIABETES (1-800-342-2383).

The American Association of Diabetes Educators (AADE): Many diabetes educators belong to this professional organization. Diabetes educators may be nurses, nurse practitioners, dietitians, exercise physiologists, pharmacists, social workers, behavioral counselors, or psychologists. You’ll find diabetes educators working at the ADA Recognized Education Programs (mentioned above). AADE also has a process for accrediting diabetes education programs. Going to an AADE accredited program ensures that you receive quality diabetes education. To find an AADE accredited program go to AADE's website and then search for diabetes educators by your city and zip code.

Diabetes: Food, Nutrition and Healthy Eating

It's critical to take diabetes seriously from day one and to make taking care of your diabetes part of everyday life. If you need to lose weight, like more than 80 percent of people with type 2 diabetes do, then take a step by step approach to achieve this goal over time. And it’s not just about the weight loss. Keeping lost pounds off is also typically quite challenging. Learn more by reading The Truths of Keeping Pounds at Bay.

How about trying to make slow and steady changes in your eating habits this way...

Perhaps during the first month you decide you will eat more fruits and vegetables and use less salad dressing, butter or spreads and/or mayonnaise. Sounds simple, but that's plenty to bite off as a first step.

Next, you may decide you want to transition from being a couch potato to taking a 15 minute walk 3 times a week. Again, not easy but put one foot in front of the other and get out there day after day.

Slowly but surely, step by step these lifestyle changes will get easier. Plus you’ll slowly trim off a few pounds and begin to feel healthier and good about your success. Yes, pat yourself on the back!

Overtime these healthier lifestyle habits will be the new way you choose to live your life. Add these changes together and they will help you control diabetes symptoms and your blood glucose…as well as potentially improve your blood lipids and blood pressure. Plus they’ll accomplish a whole lot more. Excellent bang for your effort.!

Eating with diabetes is about eating healthy, more whole grains, fruits, vegetables and low fat dairy foods. And lightening up on the meats/protein foods, fats (especially those with saturated and trans fats), desserts, and sugary foods and drinks. And of course, it's a matter of watching those portions no matter what you eat. You'll get hundreds of tips and suggestions to eat healthier in my book Diabetes Meal Planning Made Easy.

These are today's basic principles for eating healthy with diabetes. Theyse are based on research-based nutrition guidelines from numerous groups including the American Diabetes Association:

•Eat 5 servings of fruits and vegetables a day. Very few people eat enough fruits and vegetables, yet experts know these foods are packed with nutrients and low in calories. Prepare and eat salads or raw vegetables. Carry fruit with you to finish a meal or provide a snack.

Eat more foods that contain resistant starch. Eat bananas that are underripe, cooled or cold potatoes and cold rice sushi or rice salads, eat more legumes and whole grains.

Drink or eat low- or no-fat dairy foods - milk, yogurt and cheese. Use these foods in cooking. Make hot cereal with milk, use cheese in casseroles and sandwiches. Use yogurt to top fruit or enjoy as a snack or dessert.

Make protein (meat, seafood, and poultry) your side dish, not the main course. Fill up your plate with grains and vegetables and eat portions of meat that are no larger than 3-4 ounces cooked.

Lighten up on fats. Decrease the amount of butter, oil, salad dressing, cream cheese, sour cream and other fats you use. They're loaded with calories and some have unhealthy saturated fat.

Cook with and eat healthier fats. Those are particularly your liquid vegetable and nut oils. Choose what fits your taste preferences and pocketbook. Use a tub spread or butter blend with a healthier oil in place of butter when you can. Sprinkle a few nuts here and there on salads, in casseroles or as a snack.

Use healthy cooking techniques. Get away from frying and sauteing. These require fat. Try to steam, barbecue, grill, broil, bake and braise.

Put a lid on sugary foods and sweets. If you drink lots of soda or fruit juice, switch to water, ice tea, or a no-calorie beverage. Quench your sweet tooth with sugar-free hot cocoa or fudgeicles or sugar-free no fat yogurt. But do enjoy a sweet treat on occasion to prevent feelings of deprivation.

Remember: Start to make changes in your eating habits by choosing steps that are easiest for you to take! Success breeds success! Learn how here.

Is there a best eating pattern for diabetes? This is a frequently asked question and one about which a lot of research has been done. Let’s break this down.

The term “eating pattern”, which is quickly becoming a more commonly discussed concept, simply means a combination of foods or food groups that one eats day in and day out. For example, you eat foods, like a slice of bread or piece of chicken, that are in essence packages of nutrients that contain varying amounts of carbohydrate, protein and fat – from some of each to none of one nutrient and a good bit from one or the others. And due to the combination of nutrients in our foods and the way we tend to eat, there’s only so much wiggle room, particularly if you want to eat healthfully, to eat more carbohydrate and less protein and fat or visa versa.

Over the last decade or so research has been done on a variety of different eating patterns to determine whether they that can help people eat healthfully and at the same time prevent common chronic diseases like in prediabetes or type 2 diabetes, cardiovascular disease and some cancers. Specifically for people with prediabetes and type 2 diabetes do they help people achieve and maintain their glucose, lipid and blood pressure goals.

Several eating patterns were reviewed in the most recent American Diabetes Association nutrition recommendations, from vegetarian, to Mediterranean-style, to lower fat and higher carbohydrate, lower carbohydrate and higher fat and the DASH (Dietary Approaches to Stop Hypertension) eating plan (developed for the NIH DASH study in people with high blood pressure).

There’s a varying amount of research on these eating plans and varying number of studies on them conducted in people with diabetes. As researchers love to say, more research is needed! At this point in time, because nutrition research is ever evolving, it’s clear that there is no one best eating pattern for diabetes. For that matter the same can be said for the best diet for weight control.

What this research does show is that the RIGHT WAY for YOU is to through exploration find an eating pattern that you can follow now and in the future – one that fits your needs and lifestyle. There’s no ONE RIGHT WAY. What’s RIGHT is what YOU can implement and continue to follow long term.

Reality is, and research shows this, as human beings we just aren’t willing and don’t vary our eating pattern much. We may be willing for a short time, but we then gravitate back to our old ways. The approach that is more likely to succeed is making slow and steady tweaks to your current way of eating. Learn how here.

Lastly, what and how much you eat is not the only lifestyle factor you can modify to get and stay healthy. Study after study shows that other health behaviors in addition, such as being physically active, minimizing sedentary behavior (hours of sitting), not smoking, getting adequate quality and quantity of sleep at the right time of day, and limiting stress are ALL key features of a healthy lifestyle and maintaining a healthy weight.

Years ago, and still too often today, people with diabetes are sent to a dietitian to be "put on a diabetic diet." The fact of the matter is no one can put someone on a "diabetic diet" or any diet for that matter. It's up to you to choose to make changes in your eating habits to eat healthier. Today, many people with diabetes use carbohydrate counting, or as it’s abbreviated carb , counting, as a flexible way to plan their meals and if they take insulin to dose their insulin.

Carb counting has evolved to be a commonly used way to plan meals because research has shown that carbohydrate is main contributor to rising blood glucose levels after meals. All sources of carbohydrate, or foods that contain carbohydrate, including starches, fruit, vegetables, dairy foods, sweets; raise blood glucose levels albeit at varying speeds and with many other factors that come into play including the other foods you eat at the same time. For sure, blood glucose control is multifactorial.

Use carb counting to learn to eat similar amounts of carbohydrate at your meals to keep your blood glucose in control. If you have type 1 diabetes or you have type 2 diabetes and take insulin, learn to adjust your insulin based on the amount of carbohydrate you eat and your blood glucose level.

For many years people with diabetes were told to stay away from sugar, sweets and starches because they would raise blood glucose too quickly and too high. Research on this topic has accumulated over the years to prove this advice wrong. In 1994 the nutrition recommendations changed dramatically. Today sugary foods, sweets and starches are no longer forbidden for people with any type of diabetes.

What is true is that people with diabetes need to learn, like all people who try to eat healthy, to enjoy moderate amounts of sweets and sugary foods in moderation and on occasion. All sources of carbohydrate - sugary foods, sweets and starches and even fruits and vegetables - will raise blood glucose. Concentrated sources of carbohydrate, such as sugary foods and sweets can make blood glucose rise more.

The amount of sweets you can eat has everything to do with your current health and diabetes status and goals. For example a person with type 2 diabetes who is trying to lose weight and control their high triglycerides needs to keep sugary foods and sweets to a minimum due to their calorie content and impact on triglycerides. Whereas, the teenager with type 1 diabetes can likely enjoy more sweets if they know how to adjust their rapid acting insulin. Learn more about how to fit sweets and sugary foods into your diabetes eating plan in my book Complete Guide to Carb Counting.

Learn to fit sweets and other food you enjoy into your healthy eating plan by joining forces with a diabetes educator to work with to learn how much you should eat, when you should eat and how to fit the foods you enjoy eating into your diabetes eating plan. Read "How can I find a diabetes educator or diabetes education program?" to learn more.

Too many people continue to believe in and search for the one “best diet” to lose weight or get their prediabetes or diabetes under control or both. Unfortunately, even with all the nutrition research that’s been done, reality is there’s no one “best diet.”

What this research does show is that the best diet for you, or better stated best eating plan or pattern for you, is – through exploration – find a way of eating that you can follow now and in the future – one that fits your needs and lifestyle. The right eating pattern for you to achieve your weight control and/or diabetes goals is what you can implement and continue to follow long term.

Reality is, and research shows, that as human beings we just aren’t willing to and don’t vary our eating pattern much. We may be willing for a short time, but we then gravitate back to our old ways. The approach that is more likely to succeed is making slow and steady tweaks to your current way of eating. Learn more about the keys to diabetes meal planning and good diabetes control.

Though eating lower carbohydrate and higher protein diets have been touted time and time again, the research (and there's more than ever before) shows that after about six months (and that is if you can even stay on the diet this long), most people don't lose any more weight using this approach to eating than other approaches. It’s also important to consider when you’re choosing an eating pattern to make sure it’s healthful as well. Eating plans that are lower than 40 percent of calories from carbohydrate (particularly if you don’t eat more than 1500 calories a day) can have you not eating sufficient amounts of fruits, grains, legumes and low fat dairy foods. These can cause some nutritional deficient. For one, insufficient amounts of fiber and calcium.

There are many excellent diabetes cookbooks and resources for diabetes recipes available today.

When it comes to cookbooks you'll find a wide array of books, covering topics such as putting quick meals together to gourmet cooking, vegetarian cooking and many ethnic fares. I recommend that you have one or two general diabetes cookbooks on your bookshelf. These books can help you when you are getting started with diabetes meal planning and can offer you new recipes when your ideas run dry. A resource for excellent cookbooks is the American Diabetes Association.

You may find the cookbook, actually an educational cookbook, The Diabetes Food and Nutrition Bible I co-authored with diabetes culinary guru Robyn Webb, a great source for healthy recipes and so much more.

Today the internet is also filled with more healthy recipes than you'll ever have time to cook. Search for websites that offer recipes for people with diabetes or for people interested in eating healthier. Reality is that healthy recipes are just what people with diabetes need because the food and eating recommendations for people with diabetes are the same as the general public.

Recipes in cookbooks or available online usually provide the nutrition information which helps you decide if the recipe fits into your eating plan.

Healthy Restaurant Eating

Healthy eating is a challenge in general. Eating healthy restaurant meals is particularly challenging yet life today creates many situations when you need or want to eat restaurant meals. Due to the accessibility and availability of restaurants today we’re eating more meals away from home than ever before. Learn the challenges, then make healthier choices.

Treating restaurant meals as special occasions: Back a few decades ago restaurant meals were special occasions - unique events in a person’s, couple or family’s lives which took place once in a blue moon. Today people eat restaurants meals an average of five times a week. Restaurant meals run the gamut from a sub sandwich on-the-run to get the job of eating done, to celebrating special occasions – yes we still do this.

Healthier foods, fruits, vegetables, whole grains low fat dairy foods, are few and far between: The very foods you should eat more of for good health range from limited to simply missing in action from many restaurant meals.

Vegetables: You can find salads in fast food restaurants. Side salads and entrée salads are available in most sit-down American style restaurants. But you’ll have to work hard to meet that 2 1/2 cups of vegetables a day goal with restaurant food choices.

Fruit: It’s next to nil in restaurants. To get the 2 ½ cups a day you need, plan to eat fruit as part of meals at home or bring it with you to enjoy during the day.

Whole grains: Things are looking up. Whole grains are making their way onto more sandwich shop and better restaurant menus. You’ll see whole wheat or grain breads and rolls available for sandwiches in sub and sandwich shops. You’re beginning to able to order pizza made with a whole grain crust or whole wheat pasta.

Low fat dairy foods, such as milk or yogurt: Today, most fast food restaurants offer low fat milk, which is lower in fat and calories than whole milk, but not as low in fat as fat-free. Low fat milk is also available in most sit-down family style restaurants. Don’t count on milk in the majority of ethnic restaurants.

Portions are HUGE: It seems that the “value equals volume” mentality invaded restaurant meals long ago. Portions and plates to hold these massive servings just get larger. When you’re forced to order and be served large portions it’s difficult to stop eating when there’s still food on your plate.

Fats and oils are in, on, around and through: Fats and oils make foods taste good and stay moist for longer. That’s just the facts and a big reason why you see a wide variety of oils, fats and high fat ingredients used in restaurant foods from the start of the meal to the finishing touch.

Sodium levels can skyrocket: Nutrition recommendations generally suggest most people cut their daily sodium count to no more than 2,300 milligrams per day. Observing the sodium counts of many restaurant meals can help you understand why people on average eat well over the recommended amount of sodium. Many restaurant meals can top 2,300 milligrams in one sitting. Salt in foods is not as much the sodium villain today as are processed and restaurant foods which contribute about three-quarters of the sodium we eat.

The skills and strategies you’ll need fall into five categories. Read through them all. Think about which ones resonate with you and which ones you think will work well for you in different restaurant eating situations. They range from psychologically-focused to the more practical.

Develop a healthy mindset and a can-do attitude: This is your critical and crucial first step. Until you shift your mindset, you’ll have a difficult time putting other skills and strategies into action. Yes, it’s a psychological shift in your thinking. Mastering this will make using the other skills and strategies doable.

Ask yourself what changes you need to make to find a balance between continuing to enjoy restaurant eating while you order and eat healthier foods. Be kind to yourself. These changes will take some time and a repertoire of positive experiences. You can do this!

Set your game plan in gear prior to your arrival: If you’re familiar with the menu offerings from a particular restaurant you frequent, take a minute on your walk or drive to the restaurant to think through what you might order before you cross the restaurant’s threshold. If you know the menu well and are set on your order, don’t even tempt your taste buds by looking at it. Be the first in your party to order. If you want to split and/or share menu items, ask who’s willing as people peruse the menu.

Be an avid fat detective: Dodging the fats in restaurants is one of your biggest challenges. Fat adds significant calories without adding any food volume (or “bites”). Fat is the most saturated form of calories, with 9 calories per gram. Carbohydrate and protein contain half the calories, at 4 calories per gram. Therefore, lowering fat intake, even just a little can make a big impact on the number of calories you consume.

Practice portion control from the start: Large portions are a reality of restaurant meals. To cut portions down to a healthy size you’ll need to “outsmart” the menu and be creative with what you order. A successful strategy is to control portions from the start – when you place your order. The result? Less food will be in front of you and you’ll eat less. This is the “out of sight, out of mind (or mouth)” technique. It’s a lot more difficult to control the amount you eat if food is just a fork or spoon full away. To learn a few more helpful portion control strategies read "What strategies can help you control the HUGE portions of restaurant foods?".

Get comfortable making those special requests. Special requests are a key to being served foods as you like (or need) them. A special request might mean asking for an ingredient to be left off, such as cheese, bacon, and/or sour cream. Or asking for a substitution: baked potato rather than French fries or potato chips; or to spread mustard rather than mayonnaise on a sandwich. Maybe you just want an ingredient, like salad dressing, butter, or guacamole, served on the side so you control the amount you eat. Special requests might make you feel like you’re ruffling feathers or holding up other customers in line. However, there are ways to approach special requests that will put you at ease and won’t make you or your eating partners sink into their seats.

A lot of information is available and more is coming. That wasn’t the case before the days of the Internet. Today most restaurants have a website. Most chain restaurants of any size provide nutrition information for the majority of their menu items. That’s particularly true for walk up and order restaurants. It’s not the case for single location restaurants – both fine dining and ethnic restaurants.

Beyond the information available from restaurants there’s access to a number of food and nutrition databases which provide information for many restaurant foods. There are apps filled with food and nutrition information as well.

Speaking of apps, my book Eat Out, Eat Well – The Guide to Eating Healthy in Any Restaurant which contains more information about restaurant nutrition labeling regulations and some nutrition data for restaurant foods has a companion app with loads of data Eat Out Well – Restaurant Nutrition Finder. This app, based on GPS technology, contains the nutrition information for thousands of restaurant foods. It’s constantly updated with the latest information. It’s free so consider downloading it to your mobil device.

More nutrition information will be available over the years. As of late 2015 and due to an amendment in the Affordable Care Act restaurants serving the same menu with 20 or more outlets to will be required to display calories on menus or menu boards. Other data, from fat, sodium and more, must be made available to customers upon request. The restaurant must have the ability to provide you with the information at the restaurant.

Think about it. Though our focus when we order restaurant meals is squarely on what foods we’ll eat, we nearly always order a beverage. That’s true whether it’s a fast food meal or you’re going upscale. Your meal may include just a non-alcoholic beverage or may also include an alcoholic beverage. In fact, “what can I bring you to drink?” is often the first question you’re asked in a sit down restaurant.

Your choice or choices of beverages deserve as much knowledge and thought as your food options. That’s because beverages can dramatically escalate the calories you consume in a meal…or not.

A few thoughts and tips about Non-alcoholic Beverages:

From the walk up and order fast food burger and French fries chains to coffee, bagel and sandwich shops, to walk up and order ethnic restaurants, the thirst quenching options have exploded and sizes have grown. Healthier and less than healthy beverages abound. Water, from tap to bottled, is no longer hard to find. It’s usually your healthiest bet. You can usually ask for a slice of lemon to flavor water at no extra cost.

You’ll find regularly sweetened and diet soda (carbonated soft drinks) either from the fountain or in bottles. If restaurants stock bottled or canned beverages, they usually have an array from water, to fruit juice or drinks, sports drinks, teas and coffees, and soda. All sugar sweetened beverages, can pack in a load of calories and an unhealthy source carbohydrates (essentially added sugars). Today coffee and tea drinks, including calorie laden ones are plentiful too.

Making healthy non-alcoholic beverage choices can help you control your calories, carbohydrate and fat grams…and keep more change in your pocket.

The easiest way to limit those added sugars and calories is to drink fewer and smaller portions of sugar-sweetened beverages, or none at all. And for people with diabetes monitoring grams of carbohydrate, you generally don’t have enough grams to spare on beverages with added sugars.

Generally speaking I recommend you chew your calories, don’t sip them. Yes, there’s still debate about whether people consume more calories more easily if they’re sipped or slurped rather than chewed. But it stands to reason that chewing rather than sipping your calories will be more satisfying.

A few thoughts and tips about Alcoholic Beverages:

Research shows that light to moderate alcohol consumption over time can increase insulin sensitivity and decrease insulin resistance. This impact is at the center of alcohol’s beneficial effects on decreasing the risk of metabolic syndrome, prediabetes and type 2 diabetes and conveying other heart-related benefits. It may minimally raise the good HDL-cholesterol, too. Nice list of health benefits!

Keep in mind these are beneficial effects of moderate alcohol. And that’s any type of alcohol, not just red wine. Excess alcohol intake causes health problems a plenty.

How much alcohol is moderate?

The recommendation for alcohol for the general public, from the Dietary Guidelines and for people with diabetes, from American Diabetes Association, is the same. No more than a “moderate” amount of alcohol in a single day. Moderate is defined as one drink, or serving of alcohol (defined below) for women and two drinks a day for men. This moderate amount is an amount to consume in a single day and not averaged for a few days at a time.

Pitfalls of alcoholic beverages:

Calories: Alcohol contains calories with next to no nutrition to speak of. Calories from alcohol can add up quickly. A couple of 12 ounce regular beers contain 300 calories.

Safety: Alcohol is enjoyable to many people due to its fairly rapid effect on the brain which makes you more likely to order and drink more alcohol. Alcohol also makes people more relaxed and social. This is one reason it’s more common to drink alcohol when dining out and lingering over a meal or celebrating an occasion.

Develop an alcoholic beverage drinking plan. Think about when you’d like to be able to fit in and enjoy a serving or two of alcohol. Ask yourself these questions:

when do you want to fit an alcoholic beverage in?

where do you want to consume it?

what do you want to drink?

how will you fit it into your eating and diabetes control plan based on your priorities?

Controlling portions is the most important strategy to controlling the amount of food you eat. Eating less food also helps you eat less fat and sodium. Don’t wait to control portions until a plate of food is in front of you. Start from the moment you glimpse at the menu board or have a menu placed in your hands.

Research shows the more food you get placed in front of you the more you will likely eat. No surprise there!

Check out these portion control strategies. Start applying one, two or more of them as soon as you eat your next restaurant meal. Figure out which portion control strategies work best for you in various restaurant eating situations. Some might work better when you eat by yourself and others when you have two or more dining companions. Several might work better in ethnic restaurants and others in fast food or upscale restaurants.

Test out these strategies and change your restaurant eating habits over time.

Practice portion control from the get-go. Take care to order small portions or split and share menu items so you don't get more food in front of you than you should be eating...most of the time you can eat more than you should.

Split items. Often ordering one dish is enough for two. Example: order one personal pizza and share a salad. Splitting works well for desserts too. Sometimes you need more spoons or forks.

Share. Order items that complement each other and help you eat more balanced meals. Example: in an Italian restaurant, one person order pasta the other a veal or chicken entrée. Then split them down the middle.

Choose from salads, appetizers, soups and/or a la carte menu items. Request that one, such as a salad, be served as an appetizer (if your dining partners are eating appetizers) and another, such as soup or an appetizer, is served as a main course.

Don't forget those take home containers aka "doggie bags" for leftovers. You can order a take home container when you order your meal. Put away your leftovers before you dig in. Leftovers are the amount of food you don’t think you should eat at the time.

I'm often asked this question when I’m interviewed by the media. One might jump to the conclusion that several Asian cuisines, such as Chinese, Japanese or Thai are the healthiest cuisines, whereas Mexican, Middle Eastern and Italian are less healthy. When you look at the spectrum of foods served in all of these restaurants, this conclusion isn’t true. There are healthier and not-so-healthy choices in all types of restaurants that serve ethnic fare.

What is true is that YOU can CHOOSE to eat any ethnic fare healthfully. Yes, those words YOU and CHOOSE are critically important. It’s all about your menu choices and how much you eat. Word to the wise – order less to eat less! In fact, this is easier to practice in many ethnic restaurants because splitting and sharing is more the norm.

Kids growing up today will likely eat restaurant meals more frequently than ever before for the same reasons the adults in their life are - pace of life and 24/7 easy access and availability. So yes, our kids need the skills and strategies to eat healthy restaurant meals even more than adults do now. It’s up to the adults in their life to teach them these skills. Please do!

Frequent restaurant meals have been shown to contribute to obesity-related health problems in kids. Kids and teens often eat foods at or from fast food chains, sandwich shops or pizza joints. Research shows kids who regularly eat restaurant meals consume more calories, total fat and saturated fat than those who do not. And, as you would guess, they eat fewer servings of fruits, vegetables and milk.

Here are a few tips to put into action:

Make healthy eating in restaurants a family affair. Don’t practice special occasion thinking.

Develop family guiding principles for restaurant eating. That’s how you’ll order and eat together in restaurants.

Think of ordering, or better stated coordinating, your meal as a family negotiation. Have all family members discuss the items they’re interested in sharing. This typically provides ample food for everyone and offers teachable moments for children to learn healthier restaurant eating habits.

Be a role model. Actions speak louder than words. If your children see you ordering healthy foods and not overeating, they are likely to follow suit without you even whispering a word.

Don’t use those kid’s menus at sit down restaurants. That is unless they’ll help your children eat smaller portions or healthier foods and/or fit in some healthier fruits and vegetables.

Do use kid’s menus in fast food restaurant. The smaller portions and healthier food choices can help.

Widen the scope of foods kids enjoy rather than narrowing their list to what adults believe are kids’ foods. Take them to ethnic restaurants – the common Mexican, Chinese and Italian; and less common Thai, Middle Eastern or Indian. Expose them to foods and people from around the globe.

Healthy Eating: Ethnic Restaurants

Chinese food is in the top three of Americans’ favorite ethnic cuisines. While Chinatowns in major cities are one place to eat Chinese food, today it’s common to see Chinese restaurants in shopping malls and urban, suburban, and rural neighborhoods.

Interestingly, Chinese food wears a halo of health because people think of it as heavy on vegetables and light on fat. This perception may be true when foods are prepared traditionally or in China, but it’s not true of most Chinese foods prepared and eaten in American Chinese restaurants. Meals in Chinese restaurant can quickly become unhealthy and loaded with calories.

Consider this unhealthy, high fat Chinese meal: start with spare ribs or eggroll, move on to Sweet and Sour pork or Shrimp with Fried Rice and finish off with Fried Bananas. Healthy? Hardly! The Americanized preparations usually means added fat – fried appetizers and battered and fried meats (shrimp, pork) in dishes. But Chinese menu choices don’t have to be unhealthy or high in fat.

With skills and strategies in hand, it’s possible to eat healthy Chinese restaurant meals. The watchwords are pick and choose your dishes carefully, enjoy a bowl of soup to fill you up (without the crispy noodles), and share dishes with your dining partners to put portion control into action. Plan to bring home leftovers to control portions (this is why microwaves were invented)!

Chinese food can be high in sodium - choose dishes with lighter sauces, request light soy-sauce be use (when food is cooked to order), order brown rice rather than fried rice and control your portions. Less food = less sodium.

Today there’s a wide range of Mexican restaurants in the US. There are several large Mexican fast food chains and a growing number of fast-casual chains serving Mexican food. Then there’s several table service chains serving Mexican food. Last but not least in larger cities you can find upscale restaurants serving Mexican cuisine.

Most fast food and fast casual Mexican restaurants serve what’s called Tex-Mex - an Americanized version of a few items from Mexico’s diverse culinary landscape. Think nachos, tacos, burritos and chimichangas. But over the past decade or so, things have changed. Traditional Mexican herbs and spices are now more readily available in the US and chefs, particularly in upscale restaurants, are increasingly exploring and using these bold flavors.

While specific dishes may vary, Mexican cuisine typically features five essential ingredients: rice, corn, beans, tomatoes, and a wide array of chilies. These ingredients are, before being prepared, healthy—high in vitamins and minerals and low in fat. Plus, spicy toppings—red or green salsa, pico de gallo, and chilies—up your vegetable count and adds great flavor with next to nil calories.

There’s minimal focus on animal protein in Mexican food compared to a typical American meal. Compare the small quantity of meat, one to two ounces, in one enchilada to our familiar eight-to ten-ounce steak. This has its roots in the old Mexican practice of making a small amount of meat feed many mouths (a common thread in many ethnic cuisines). Soft tacos filled with beans and vegetables, chicken enchiladas, grilled fajitas, and fresh salads are just a few of the healthier dishes you can choose.

However, the health attributes of traditional Mexican ingredients can be quickly squashed if foods are fried, refried, or smothered with cheese or sour cream, as they often are in Mexican cuisine. Think of dishes such as loaded nachos, quesdaillas, chimichangas and Mexican salads served in the fried tortilla bowl.

Fat, like in many restaurant foods, is clearly the villain when you’re trying to eat a healthy Mexican restaurant meal. There are many fried items, and many Mexican recipes traditionally call for the use of lard or animal fat drippings. Both of these items contain cholesterol and saturated fat. Due to pressure to improve the healthiness of their foods, large restaurant chains have switched to using healthier liquid oils.

Mexican food can also be high in sodium. Salt is used in many recipes and sauces, and a lot of the prep work is done in advance, such as spicing meats to stuff into tacos or burritos. This makes it difficult to request that salt be omitted. However, if you order a dish such as grilled chicken, fish, or beef in an upscale Mexican restaurant, you might be successful with a “hold-the-salt” request because they might cook from scratch.

Chips, salsa, and large amounts of cheese can also contribute to raising the sodium level. Due to its zesty taste, green or red salsa can be used to add punch to salads or chicken and fish dishes, and salsa is fine to use in small amounts.

One more stumbling block, particularly in sit-down restaurants are the large portions – think combo plates. This can escalate your calorie count. Strategies to use at Mexican restaurants are: watch the portions in your entire meal, say no to high-fat toppings like cheese and sour cream, and avoid anything deep-fried.

These are a few healthier dishes you'll find on most Mexican restaurant menus:

Today there are more Japanese restaurants in America than ever before, particularly sushi-focused types. That’s great news because with less navigating than in most restaurants you can enjoy a healthy Japanese restaurant meal.

You’ll find Japanese restaurants from metropolitan areas to our suburbs and from airports to food courts. Generally speaking, they’re one or maybe two of-a-kind restaurants. A few Japanese restaurant chains exist, but they’re mainly Japanese steak houses.

The menus in traditional Japanese restaurants typically serve Japanese favorites, from tempura, sukiyaki and teriyaki along with the less well known dishes agemono, yosenabe and donburi.. These restaurants may also boast a busy sushi bar that keeps multiple sushi chefs’ hands busy rolling up both familiar and exotic rolls. However, with the popularity of sushi, that’s all some Japanese restaurants serve.

Another category of Japanese restaurants popular with younger diners (kids) and therefore families are the Japanese steak houses. These restaurants spotlight their aerobic chefs who turn meal preparation into a tableside acrobatic performance and as a side dish turn out tempting chicken, shrimp, or beef teriyaki complimented with rice and vegetables.

Japanese cuisine accents carbohydrate in rice, noodles and vegetables and minimizes fats by using food preparation methods that require little or no oil or fat, such as steaming, braising, or simply serving it raw. Another big plus is the relatively small portions.

The sodium count of Japanese meals can be quite high due to the soy-based items. Marinades and sauces, whether for teriyaki, sukiyaki, or shabu-shabu, are a combination of some or all of the following: shoyu, dashi, mirin, sugar, sake, and a bit of kombu.

These are a few healthier dishes you'll find on most Japanese restaurants menus:

Thai restaurants are a newer addition to the American restaurant scene, but Thai food has quickly caught on leading to a proliferation of restaurants. The majority of Thai restaurants are in larger cities. They cling to our two coasts. Most Thai restaurants are independently owned or the restauranteur may have a few locations in a similar geographic area.

At this point there are no Thai chain restaurants. A few Chinese-oriented chains have noticed the mass appeal of Thai flavors and added some popular Thai dishes to their menus. Thai foods and flavors are integrated into other types of menus. You’ll find Thai ingredients on pizza and Pad Thai, the favorite noodles dish, on American type restaurants.

Thai cuisine is often compared with Chinese, but the similarities don’t go much beyond the preparation method of stir-frying, the central role of rice and noodles, and a cadre of similar vegetables. As for end results, Thai food differs substantially due to the use of many different herbs and spices. In fact, taste wise, Thai food more closely resembles Indian fare with its use of aromatic flavors and spices—coriander, cumin, cardamom, and cinnamon, to name a few.

Though Thai cooking is generally light and healthy, fat does creep in from various sources, though not nearly as much as in Chinese food. Most appetizers are deep fried and many entrees are stir-fried. If you frequent a particular Thai restaurant, ask what oil they use and make sure they say no to animal based fats (lard) in favor of vegetable oils.

Another source of fat is coconut milk, which is used in Thai cuisine to create dishes with curry sauces. Coconut milk, similar to coconut oil, contains saturated fat, as well as a hefty dose of calories. One quarter cup of coconut milk—the amount you might have in a Thai curry dish that you split in half—contains 110 calories, most of which are from saturated fat. To limit this unhealthy ingredient, limit the amount of dishes with coconut milk, such as curry entrees and soups that are not crystal clear.

The sodium content of Thai food also can run high. The spicing and flavoring is not as dependent on soy sauces as in Chinese cuisine. However, it is not uncommon to see soy sauce and/or salt added to main dishes, soups, rice (other than steamed), and noodle dishes. Some of the sauces, such as yellow bean paste, shrimp paste, and fish sauce also add sodium.

These are a few healthier dishes you'll find on most Thai restaurants menus:

Healthy Eating: Fast Food/Chain Restaurants

Over the last few decades, fast food chains, those walk up and order type of restaurants, have made moves to satisfy the desire for healthier options. Today you can order salads with lower calorie dressings, grilled chicken sandwiches, baked potatoes and six inch subs on whole grain breads. And healthier beverages are available. Read more about drinking healthier non-alcoholic and alcoholic beverages in restaurants.

Another plus, kid’s meals today are healthier too with healthier sides and served with low fat milk, unless you ask for a different drink.

Despite this handful of positive changes and the fact that you can eat healthier fast food meals if you try, the truth is that fast-food meals are generally high in calories, fat, saturated fat and sodium. They’re also lower in healthier sources of carbohydrate than desirable – light on vegetables unless you have a salad as a main course or side, fruit is missing in action (as in most restaurants) and there are no whole grains to speak of.

But fast food restaurants actually can make healthy restaurant eating easier than at sit down restaurants. No foods are set before you at your table before you order. Thus no food to resist! You don’t have to wait for your food. It’s order and eat. You can order food in various portion sizes, from kid’s to small to jumbo. Plus, the nutrition information for fast food restaurant foods is readily available. Learn more about the nutrition information currently available from restaurants today [link to this Q in section 1 – the Q about nutrition information. Another convenient source for fast food nutritional info is Eat Out Eat Well’s [link] free companion app Eat Out Well – Restaurant Nutrition Finder [link] which you can download to your mobile device.

Here’s a few tips to put into action:

Minimize Fried Foods. Better yet, skip them all together: Offset one fried food with a grilled or non-fried item. For example, opt for a small order of French fries (or share a medium order) with a no-frills hamburger or a grilled chicken sandwich.

Don’t let the fat sneak in: Be mindful of all the ways fat can sneak into your meal. In fast food restaurants minimize or avoid cheese, bacon, mayonnaise and “special sauce” (which are often mayonnaise-based.

Limit Sodium: Fast-food meals can send your sodium count skyrocketing. The sodium count ticks up as foods are coated in salty batters or as pickles, special sauces, bacon, cheese, and salad dressing are added. Not to mention the salt shaker used on French fries or salt on bags of chips and other crunchy snack foods.

Have a Plan: The fine art of preplanning is a bit easier in fast-food restaurants. You aren’t greeted with a menu to peruse and tempt your taste buds. You know only too well what’s on the menu board. A healthy practice is to decide what you’ll order before you cross the threshold or hit the drive-thru speaker.

Control Your Portions: The portions can be small as long as you order using the words small, regular, junior, small, or single. Skirt around the words that mean large portions: giant, super, jumbo, double, triple, big, and extra-large. A single hamburger has between two and three ounces of meat, just about the right portion for lunch or dinner.

Eat Mindfully: Monitor your pace of eating. Make sure you take at least 15-20 minutes for a meal. Avoid drive-thru windows – they partner eating and driving. Not a good combination for your weight or your safety.

Fast-food meals are generally higher in calories, fat, saturated fat and sodium. They’re also lower in healthier sources of carbohydrate than desirable – light on vegetables unless you have a salad as a main course or side, fruit is missing in action (as in most restaurants) and there are no whole grains to speak of. Despite this handful of positive changes and the fact that you can eat healthier fast food meals if you try, the truth is that it’s tough to eat a healthy fast food meal.

Test out a few of these tips for healthier fast food meals:

Order a kid’s meal. They don't card you to make sure you're under a certain age. Often the size of the servings and portions are just right. Today these meals come with a vegetable instead of fries and may even get you a serving of fruit as apple slices or a clementine.

Go for the small or regular size sandwiches. Don't order large, extra large, super, or jumbo. It's too much food. Unless you plan to split and share.

Don't be taken in by offers for more food or less money. That’s those two for one offers or meal deals.

Split a small or medium order of fries. Think about it. You’ll likely be satisfied with just a few bites of those crisp and crunchy fries.

If a salad is available, order it. Today entrée, half entrée and side salads are available at most fast food restaurants. This is great. You can crunch on something not fried and chock up a vegetables serving or two. Do be careful with the salad dressing. Drizzle lightly or just dip your greens lightly.

Today sub shops and pizza restaurants are plentiful and frequented as often as fast food burger and fries chains. By implementing a few strategies to control fat, minimize portions and eat more vegetables you can eat healthier meals in or from restaurants focused on sub sandwiches and pizza.

Take advantage of those 6" subs. That's portion control at work. Pair that sub with a healthy bowl of soup (broth-based or bean-based).

Subs are made to order. That’s good news. Use it to your advantage. Watch the preparer carefully and tell them what you want piled high and what you want left out. For example: Leave off mayonnaise, oil, dressing. Add on more lettuce, tomato, onion, pickles, peppers, vinegar and/or mustard.

Split that bag of chips. Better yet, order a side salad.

Pizza - go heavy on the healthier vegetable toppings. Go light on the meat and extra cheese topping. Then stop at 2 to 3 pieces.